背景:本研究旨在研究美国锁骨远端切除术(DCE)中与患者人口统计学和医院特征有关的国家趋势。
方法:查询国家门诊手术样本(NASS)数据库中的数据。选择了具有当前程序术语(CPT)代码29824的遭遇。从这些遭遇中得出的指标包括患者人口统计信息,如年龄、地理位置,每个邮政编码的家庭收入中位数,和主要预期保险付款人。得出的医院特征包括DCE程序的总费用,医院的位置,病人的性格,医院普查区,医院的控制权/所有权,以及医院的位置/教学状况。还分析了与肩袖修复(RCR)同时进行的DCE的比例。使用具有线性回归模型的t检验从连续变量获得P值。使用卡方分析从事件变量获得P值。
结果:美国关节镜DCE的发生率从2016年的99,070下降到2018年的93,678(5.5%)。值得注意的是,与RCR同时进行的DCE比例从2016年的50.4%显著上升至2018年的52.8%(P<0.0001).从2016年到2018年,患者年龄中位数增加(56.4至57.2;P<0.0001)。遭遇次数最多的收入四分位数在$43,000和$53,999之间(P<0.0001)。医院趋势显示,在研究期间,费用从16,944美元增加到18,855美元(P=0.0016)。私人保险,包括健康维护组织(HMO),是这一程序的最大付款人;然而,私人保险覆盖的DCE呈下降趋势(50.2%~47.3%;P<0.0001)。医疗保险是第二大支付者,从2016年的27.9%到2018年的29.9%。在医院的城市教学模式中,遇到此程序的次数仍然最多。
结论:在2016年和2018年,私人保险是最常见的付款人,大多数DCE是在城市教学医院进行的,大多数接受手术的患者的家庭收入中位数在43,000美元至59,000美元之间。2016年至2018年间,与DCE相关的成本大幅增加,以及接受手术的患者的中位年龄增加。在研究期间,与RCR同时进行的DCE的比例也显著增加。
BACKGROUND: This study aimed to examine national trends pertaining to patient demographics and hospital characteristics among distal clavicle excision (DCE) procedures performed in the United States.
METHODS: The National Ambulatory Surgery Sample (NASS) database was queried for data. Encounters with Current Procedural Terminology (CPT) code 29824 were selected. Metrics derived from these encounters included patient demographic information such as age, geographic location, median household income per zip code, and primary expected insurance payer. Hospital characteristics derived included total charges for DCE procedures, location of the hospital, disposition of the patient, hospital census region, control/ownership of the hospital, and location/teaching status of the hospital. The proportion of DCE performed concomitantly with rotator cuff repair (RCR) was also analyzed. P-values were obtained from continuous variables using a t-test with a linear regression model. P-values were obtained from event variables using chi-square analysis.
RESULTS: The incidence of arthroscopic DCE in the US decreased from 99,070 in 2016 to 93,678 (5.5%) in 2018. Of note, the proportion of DCE performed concomitantly with RCR significantly increased from 50.4% in 2016 to 52.8% in 2018 (P < 0.0001). Median patient age increased from 2016 to 2018 (56.4 to 57.2; P < 0.0001). The income quartile that saw the highest number of encounters was between $43,000 and $53,999 (P < 0.0001). Hospital trends display an increasing cost from $16,944 to $18,855 over the study period (P = 0.0016). Private insurance, including health maintenance organizations (HMOs), were the largest payers for this procedure; however, a decreasing trend in DCE covered by private insurance was noticed (50.2% to 47.3%; P < 0.0001). Medicare was the second-largest payer ranging from 27.9% in 2016 to 29.9% in 2018. The urban teaching model of hospitals continues to see the highest number of encounters for this procedure.
CONCLUSIONS: In both 2016 and 2018, private insurance was the most common payer, most DCEs were performed in urban teaching hospitals, and most patients undergoing the procedure had a median household income between $43,000 and $59,000. Between 2016 and 2018, there was a significant increase in costs associated with DCE, as well as an increase in the median age of patients undergoing the procedure. The proportion of DCE performed concurrently with RCR also significantly increased during the study period.